Funding cuts for homoeopathy

The Guardian, Times and BBC are today reporting that National Heath Service funding for homoeopathy is on the decline. A survey conducted by Pulse has found that only 37% percent of the UK’s primary care trusts are still funding homoeopathy services, with more than 25% having reduced funding to homoeopathy in the last two years.

The real news, I would argue, is that more than a third of the UK’s funding bodies are still funding the alternative medicine.

The Cochrane Collaboration conducts meta-analyses of scientific trials to arrive at best informed judgments on the effectiveness of medical treatments. For all homoeopathic treatments investigated (dementia, asthma, and attention deficit hyperactivity disorder), it has found no evidence of a significant benefit over placebo. Other reviews have also found that homoeopathic treatments for cancer and osteoarthritis lack any benefit over placebo, and the Lancet published a study in 2005 suggesting that all observed effects of homoeopathic treatment can be attributed to the placebo effect. There is also no plausible explanation for how homoeopathy could outperform placebo. Standard homoeopathic medicines are developed by diluting a solution to an extreme degree, often to the point that it no longer contains any active ingredient.

So what arguments could there possibly be for funding homoeopathy? I can think of two. (1) The placebo effect of homoeopathy justifies its public provision.(2) The popular support for homoeopathy justifies its public provision

In response to (1), some might claim that it is unethical for doctors to prescribe placebos, so public funding for homoeopathy would simply serve to encourage unethical behaviour on the part of medical professionals. However, it is in fact rather difficult to argue that doctors should never prescribe placebos. The obvious objection to such prescriptions is that they are somehow deceitful: they rely for their efficacy on the doctor concealing her true beliefs about the treatment’s biological effects. But imagine a patient asking his doctor to, from time to time, prescribe placebo treatments without revealing whether any particular treatment is a placebo or not. There would seem to be nothing necessarily irrational about such a request. And given such a request, though subsequent placebo prescriptions might still be deceitful in some sense of that word, they would not be deceitful in any problematic way.

There are, however, other reasons for finding (1) unpersuasive. In making rationing decisions, health funders face a choice between competing treatments, and it is difficult to see why the should fund homoeopathic treatments on the ground that they have placebo effects in preference to other treatments which have both placebo and ‘genuine’ effects. There are, after all, many such treatments that remain unfunded or tightly restricted. Thus, in order to qualify for public funding it would seem that homoeopathic treatments would have to have a placebo effect which is so much stronger than that for conventional treatments that it offsets any ‘genuine’ effects of the latter. There is, as far as I am aware, no evidence that this is the case.

Is argument (2) any more persuasive? I doubt it. We do not generally accept the principle that healthcare funding should be based directly in popular preferences. If we did, we might well be committed to reducing funding for mental health services (since the mentally ill are often regarded as at fault for their conditions), treatments for diseases that only effect certain minority groups (since the majority has no self-interested reason to support the public funding of such treatments), and treatments provided to certain unpopular groups (such as criminals). But on reflection, most of us (even, presumably, those with whom these treatments are unpopular) can recognise that funding for such treatments should not in fact be reduced merely because they are unpopular. That is because we can recognise a role for rational ethical deliberation in making rationing decisions, and we doubt that unreflective preferences should have any role to play in this deliberation.

It is precisely at this hurdle of rational deliberation that homoeopathy, given it’s relative lack of therapeutic benefit, should, I would argue, be rejected. That 37% of primary care trusts are still funding homoeopathy despite its relative lack of benefit strikes me as evidence that their rationing decisions are not fully rational.